Pregnancy After “a Choice to Drink”: Meanings of Autonomy in England's Policies on Fetal Alcohol Spectrum Disorder

There are few areas of social life where the paradox of autonomy is played out more continually than with pregnancy. This chapter considers meanings ascribed to autonomy through discussing an analysis of policy documents about fetal alcohol spectrum disorder (FASD) published by health authorities in England. These documents justify a suite of health interventions presented as necessary to prevent this disorder in those yet to be born and to address the health and care needs of those who may be diagnosed with FASD after birth. The prevention aspect of the policy framework and its concepts of autonomy in pregnancy are focused on. Context is provided through an account of scholarship detailing ways the “choice to drink” became compromised since the “discovery” of Fetal Alcohol syndrome (FAS) in the early 1970s. Conceptualizations of autonomy associated with what the chapter terms a “post-choice policy framework” are then detailed, with attention paid especially to what policies say about providing and collecting information. It is argued that concepts of autonomy are modified, as autonomy for pregnant women both appears and disappears as a consideration. Either way, autonomy is given a meaning that makes its existence contingent on professional influence, diminishing space for maternal judgement.